Finasteride to prevent prostate cancer: should all men or only a high-risk subgroup be treated?

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Andrew J VickersHans Lilja

Abstract

PURPOSE Finasteride has been shown to reduce the incidence of prostate cancer. Yet the use of finasteride remains low, likely because of the risk of adverse effects. We sought to determine whether prostate-specific antigen (PSA) levels could identify a high-risk subgroup for which the benefits of finasteride treatment outweigh the potential harms. PATIENTS AND METHODS Raw data from the Prostate Cancer Prevention Trial were used to model chemopreventive treatment strategies: treat all men, treat no men, or treat a high-risk subgroup based on PSA level. We weighted the benefits (reduction in cancer rate) and harms (treatment rate) of each strategy using numbers-needed-to-treat thresholds-the maximum number of men a clinician would treat with finasteride to prevent one cancer. Results Of 9,058 men, 1,957 were diagnosed with prostate cancer during the 7-year study. For the end point of all cancers, including both for-cause and end-of-study biopsies, the optimal strategy is to treat all or nearly all men. To reduce risk of cancers detected through routine care, treating men with PSA > 1.3 or > 2 ng/mL is optimal. For example, treating only men with PSA > 2 ng/mL reduced the treatment rate by 83% and resulted in a cancer rate only 1....Continue Reading

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Citations

May 1, 2010·Nature Reviews. Clinical Oncology·Nick Groves-Kirkby
Feb 18, 2011·Annals of Oncology : Official Journal of the European Society for Medical Oncology·M YassaP Giraud
Sep 17, 2011·BMC Medicine·Robert J Hamilton, Stephen J Freedland
Dec 15, 2010·Future Oncology·Sarah L Hulin-CurtisJuergen K V Reichardt
Nov 30, 2012·Urologic Oncology·Kenneth G Nepple, Gerald L Andriole
Jan 28, 2015·Urology·Andrew J Vickers, Daniel D Sjoberg
Apr 17, 2010·Nature Reviews. Urology·Nick Groves-Kirkby
Mar 1, 2012·Expert Review of Endocrinology & Metabolism·Michael YassaPhilippe Giraud
Jul 7, 2012·International Journal of Molecular Medicine·Eduardo Parra

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